Love On Call

Mari took a deep breath and hurried into her room, quickly scanning the instruments set out beside the exam table. She pulled on gloves just as a stream of first responders burst into the ER pushing stretchers toward the rooms where Bruce had directed them. Two EMTs angled a stretcher into Mari’s cubicle with a small form nearly dwarfed by oxygen tanks, an EKG monitor, and IV bags. All Mari could make out beneath the tape and O2 bag was a blue-tinged face and a shock of yellow hair.

A heavyset redhead at the front of the stretcher croaked hoarsely, “Juvenile, maybe ten years old, buried in three feet of dust—” He lost his voice for a second, then continued, voice steadier although agony misted his eyes. “The family had already dug him out, and the dad was doing mouth-to-mouth. We intubated in the field.”

“Pulse ox?”

“60.”

Mari’s stomach plummeted. 60 was barely compatible with life and not enough to sustain brain function. She quickly listened to the boy’s small chest and could hear no air moving in the lower two-thirds of his lungs. Thankfully she detected a rapid heartbeat, but that wouldn’t last long if they couldn’t ventilate him. “On a hundred percent O2?”

“That’s what’s running, but it doesn’t seem to be doing much good.”

Mari glanced at Beverly, a middle-aged brunette nurse who’d arrived to help. Her mouth set into a tight line, and Mari didn’t have to ask why. If they did nothing, this child was dead. But no matter what she did, it probably wouldn’t make a difference. Still, her job was to fight, as long as reasonable, and fight she would.

“All right,” Mari said, hoping she sounded confident, since she hadn’t actually heard of what she planned to do being used for anything like this. Although she hadn’t heard of this until ten minutes ago. “Let’s set up a saline lavage, get another pedi tube ready.” She looked up at the two EMTs. “What size do you have in there?”

“Six,” replied the second EMT, a thin young blonde with a silver hoop through the corner of her left eyebrow.

“Who intubated him?”

“I did,” the blonde said.

“Did you see debris in his trachea?”

“I didn’t see anything. It was a blind intubation.”

“All right then, let’s see what we can see.” She ought to clear this treatment with someone before she went much further. “Beverly, can you get Dr. Remy or Glenn for me?”

“Not for a few minutes,” Beverly said. “I saw them both at a resuscitation on my way in here.”

“We don’t have a few minutes,” Mari muttered.

“Let’s not waste any time, then,” Beverly said briskly, as if telling her to do what she needed to do. She stood by with suction and a small-bore catheter connected to a saline bag under pressure.

“Time me.” Mari took a deep breath and slid out the breathing tube, removing the only thing keeping the boy breathing—and alive. She didn’t have long, but then, neither did he. She slid in her laryngoscope and lifted his chin, giving herself a narrow tunnel down which to evaluate his airway. The thin light at the end of the instrument illuminated the back of his throat and the upper part of his trachea. Where she should have seen glistening pink mucosa she saw only thick clumps of dark debris. It looked as if someone had poured concrete into his windpipe. No wonder he couldn’t breathe.

“Let me have the lavage catheter.”

Beverly slid the thin tube into Mari’s hand and she threaded it down into the debris and hopefully into his trachea. “Go ahead, open up the bag and get the suction ready.” Fluid shot into his trachea, completely blocking what remained of his airway. If this didn’t work, he’d drown. The saline mixed with the dust from the grain silo, threatening to glue shut any possible avenues for airflow, and Mari frantically suctioned before the mixture turned into paste.

“Time?”

“Thirty seconds,” Beverly said.

“Another fifteen seconds,” Mari said, the muscles in her shoulders starting to ache.

The curtain twitched back and Abby Remy looked in. “What’s the story?”

“Foreign material in the airway. Some kind of thick, particulate matter—dust, I guess,” Mari said without looking up. “He was tubed on arrival, but not oxygenating. We’re lavaging to clear the trachea and mainstem.”

Abby threaded her way between the EMTs, who hadn’t budged, to the head of the table and looked over Mari’s shoulder. “Lift the laryngoscope a little bit more so I can get a better view.”

Mari took a deep breath and lifted. Now her arm was beginning to shake. Keeping the jaw open and the airway exposed was strenuous, and she hadn’t intubated anyone in almost a year.

“How long on the lavage?” Abby asked.

“Forty-five seconds.”

“O2 sat?” Abby called out.

“58,” the male EMT reported.

Mari’s stomach plummeted. She was going to lose this boy.

“Keep going. You’ve almost got it,” Abby said quietly, her sure, certain tone injecting much-needed strength into Mari’s aching arm. “You want me to take over?”

“No,” Mari said just a bit breathlessly. “He’s almost clear.”

“There you go,” Abby said with a note of victory. “The suction fluid is coming back clear.”